Santino was greeted by SLP as he finished with Marcus. Upon entering, he was refusing water offered. He was whining and continued to refuse. Marcus reported he did well for him in the previous session. It was explained that Santino has been drinking out of the water bottle and it is being recommended he continues to drink from the water bottle versus the soft spout sippy cup to promote age appropriate cup drinking and oral motor skills. Santino transitioned to the table, continuing to appear agitated. A hug and embracing squeezes to the arms were provided to assist with calming down , which was effective. With the blue chewy tubing, he began to stim on it visually however did not bring it to his mouth. When SLP assisted, he tapped to his lips however did not open for the tubing. He continues to be orally guarded. He assisted with opening the chocolate pudding without aversion. Santino immediately stuck his index finger in and began to stick both hands in the pudding without aversion. IT WAS GREAT!! He was exploring for a few minutes and appeared to enjoy the tactile input it was providing for him. We went to the bathroom to wash hands. He assisted in scooping the pudding into a bowl with ease. When playing with the chosen toy, a small amount was offered which he leaned in for with pursed lips. He licked his lips in 3/6 trials. When he was offered more pudding or cookies, he requested pudding while pushing the cookies away. Santino continues to make progress with decreasing aversion, increasing acceptance of interacting with food, and keeping the experience less stressful yet challenging. He's doing well overall. He also drank from the mini water bottles 6x with minimal push back. It was a great session today . I will see him Monday

Christopher eagerly shared new plush toys he had with him today. This afforded an opportunity to expand into short narrative generation. Scaffolding supports facilitated increased cohesive thoughts to support sequential, linear narrative generation. Strong support to generate novel action sequences with natural dialogue vs previously heard exchanges was provided this session.
Additional activities focusing on expanded conversational reciprocity were highlighted today. Familiar cue supports were provided in order to facilitate increased conversational contingency, and provision of increased vocabulary specificity.

Santino smiled upon social greet, sustained engagement as he followed line of regard to reach for his backpack. He verbally labeled each number of the keypad code as he pushed each button, supported by phonemic cue for each. Upon entry into his room, he rapidly scanned the activities offered, reached to place the task of choice on his sentence strip and verbalized his request. Support to increase word order and clarity was facilitative. Additional activities presented allowed for expanded sentence form within requests. Natural gesturing to shift attention to pictures in order to utilize pictures as supports for sentence structure and clarity, paired with anticipatory/phonemic carriers continues to be extremely facilitative. Additional activities presented in cycles of 8 focused on facilitation of varied Agent+Action, Action + object sentence forms. Supports to increase use of expanded sentence form to request assistance
( "Help me + action/action sequence") were facilitative as well. Emphasis placed on sentence expansion to move forward from earlier forms (I want help). Periods of imitation cycles (16) were again facilitated following expanded RMT, and HANDLE activities. Strong session today.

Christopher excitedly shared a new poster that he had been working on. This afforded an immediate opportunity to discuss the familiar topic of character traits, expanded use of attributes as well as similarities and differences. Further expansion into short narrative tasks was supported with strong scaffolding. Opportunities to explore use of "tv" or "you tube talk" were numerous following discussion of his poster board. Supporting comprehension of expressive phrases used in conversation was targeted. Increased movement sequences to support attention this session were provided, as Chris agreed that " thoughts are pulling him away from thinking together today."
Subsequent re-visiting earlier categorical inclusion activities allowed for increased task success this session.

Santino engaged for sustained social greet, and followed line of regard with gesture to reach for his backpack. Upon entry into his room, he immediately scanned activities within his visual field and reached to utilize pictures to request paired with verbalization. Supports provided to increase sentence construction success. Extended participation in tasks chosen allowed for expanded use of carrier phrases and natural reference to support verbalizations across 2 activities. Additional choices resulted in gentle protest, subsequently supported with yes/no personal choice questions, visual "no" picture presentation and verbal models. Movement activities were subsequently presented. Expanded RMT movement sequences, (backsliding, wipers, etc.),HANDLE activities, (face tap, buzz snap, jiggle bridge etc.) facilitated strong periods of engagement, and natural imitation sequences. Santino in turn, lead imitation cycles, actively seeking a response for 22CYCLES ! As the session came to a close, and imitation movement patterns were completed, and clearing the table of materials began, he verbalized "no," got up from his chair, and sat down on top of my feet. Gentle transitional supports were provided, as he was clearly indicating his desire to continue the session activities. He subsequently reached for the schedule, and independently placed my picture in the pocket, reached for Dorothy's picture, and competed the sentence carrier "It's...... "time for Ms. Dorothy." Such a strong session.

Santino was greeted by SLP while finishing with Marcus. Santino reportedly appears tired today and he has been doing well eating yogurt. He reportedly interacted with fruit today without aversion - that's fantastic! He transitioned well to the table with SLP direction. Santino assisted with setting up our first activity making homemade peanut butter cracker sandwiches without the use of reinforcer. He assisted with taking the club crackers (new) and opening the peanut butter. With SLP model, he assisted with scooping the peanut butter out of the dish and spreading it on the crackers. Minimal facial grimace was elicited however he remained calm throughout the activity. There was slight finger splaying (demonstrating tactile aversion) and intermittent wiping his fingers on the table when the peanut butter got on his finger. SLP directed his finger toward his mouth and Santino independently came to his finger without aversion. He did not attempt to wipe it off. He pursed his lips back and forth demonstrating some interest. He did lick off his lips 2x with slight facial grimace. He assisted in putting the cracker sandwiches together and cutting them with ease. Santino independently requested train tracks, therefore assisted with clean up of peanut butter cracker sandwiches. When the chocolate chip cookie Gripz were introduced, SLP just gave Santino some to see what he would do. He reached toward SLP's mouth to feed. He turned away from the cookie when SLP said "you can eat them". Santino appears to be more anxious about food when the expectation is to eat, rather than simply interact. When crumbs were presented, Santino tapped to his lips 10x without aversion, he licked them of f 5/10. When cues to open "ah", Santino slowly opened his mouth with hesitation however accepted crumbs of cookies 4x. He gagged 1/4 when there was no effort to chew, he grimaced and gagged. He was observed to continue to interact with the cookies. When Santino was directed to drink water from a small water bottle, he did with ease. He took very small sips 7x with slight grimace. Santino continues to demonstrate increased trust with food with less guard. He is more willing to interact with food without stress. As stated before, his relationship with food is improving. I will see him next week!

Santino was seen for session 10 of 11 in Term 3 with this SLP and transitioned calmly between sessions. He seemed quite engaged, happy and giggly as he requested several belly tickles, verbally, "I want belly tickles", paired with eye contact. He seemed pleased to receive a Valentine's Day gift, delivered to his room by a fellow student, and responded "thank you" when prompted, verbally...The daily, visual schedule was referenced and reviewed. Santino verbalized "Miss Sharon", "Miss Ingrid", and "Mom" to complete First/Then Phrase Sequences. Water and food choices were presented but rejected...Goals for the session remained consistent and included the following...1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities. 5. to develop single-word requesting via eye gaze, picture exchange and/or verbalization...Consideration has been given to expand upon Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...Santino sat in the brown chair upon verbal direction and was directed to the abstract paint art completed during session 9 in preparation for a Valentine's Day Gift for Mom. Santino responded accurately via spontaneous verbalization to WH-?s x 11 pertaining to shape (heart) and letters required to spell "Santino" and "Mom". He verbalized, "Happy Valentine's Day" x 2 when prompted via initial phonemic cue...Santino was directed to a choice of 2 familiar activities and requested via spontaneous verbalization, "I want Mickey Shapes". Increased visual stimulation with regard to requested shapes was noted throughout. Attempts to engage and enter into two-way purposeful interaction were unsuccessful. Responses to "ALL Done/More Mickey Shapes?" were not noted. This SLP presented a familiar "Something Else", Opposites Puzzle Pairs. Santino seemed immediately engaged and verbalized the following: "fast, slow, thin, fat, light, heavy, up, down, happy, sad" as he connected each opposite puzzle pair...Santino assisted with clean-up upon verbal direction. The session came to a close in the usual manner with the "Good-Bye" Song and reference/review of the daily, visual schedule in preparation for dismissal. Santino verbalized the following: "Good-bye Miss Sharon" and "lunch box, backpack, Miss Ingrid and Mom" to complete the First/Then Phrase Sequences. Santino completed the sentence, "Remember to tell Mom Happy....Valentine's Day" x 2 when prompted with "Happy" and the initial "V" phonemic cue...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings...

Santino was seen for session 9 of 10 in Term 3 with this SLP and transitioned calmly between sessions. The daily, visual schedule was referenced and reviewed. Santino's "pull-up" was checked and judged to be very wet. Santino appeared calm as he participated in the typical routine to change in the restroom. Santino verbalized the following paired with photo reference to complete the phrases initiated by this SLP: We need to change the..."Pull-Up",
We're going to the..."Restroom", Let's wash hands in the..."Sink", Get some..."Soap", Get a ..."Paper Towel". Santino transitioned calmly back to the individual classroom...Goals for the session remained consistent and included the following...1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities. 5. to develop single-word requesting via eye gaze, picture exchange and/or verbalization...Consideration has been given to expand upon Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...A paper cup containing approximately 4 oz. of water was offered to Santino upon re-entry into the classroom. He sat in the blue chair, took small sips and drank all of the water over a 10-minute period with hand-over-hand assistance to hold and the bring cup to his mouth...Santino was directed to paper and "squeeze paints". He sat in the brown chair upon verbal direction. During the remaining 15-minutes of the session, Santino engaged in squeezing multi-colored paints onto paper which was folded then rubbed to spread the paint in an abstract manner. Santino appeared to enjoy viewing his creation as the paper was opened to reveal his design...Santino assisted with clean-up upon verbal direction. The daily, visual schedule was referenced and reviewed in preparation for the next session...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings...

Santino was seen for session 8 of 8 in Term 3 with this SLP and transitioned calmly between sessions. The daily, visual schedule was referenced and reviewed. Santino's "pull-up" was checked and judged to be very wet. Transition to the restroom to change both the "pull-up" and pants was required. Santino appeared calm as he participated in the typical routine...Goals for the session remained consistent and included the following...1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities. 5. to develop single-word requesting via eye gaze, picture exchange and/or verbalization...Consideration has been given to expand upon Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...Santino was directed to an array of 4 planned activities. He referenced the photos, selected one, then requested a familiar activity via verbalization paired with photo exchange, "I want dinosaur!". The "Stegosaurus-Build and Play Dinosaur" was presented...A battery-powered "drill" option was labeled and demonstrated by this SLP. Santino verbalized immediately, "I want drill". He appeared intrigued by the tool once again. Maximum hand-over-hand assistance was provided to operate it throughout the activity. Santino disassembled and reassembled the dinosaur with maximum assistance and appeared less frustrated by the minor changes in the process and function of the tool today. He requested via photo reference/exchange paired with verbalization x 10: "I want...+ the following: dino head, tail, plates, front leg, back leg" and "I want screw" x 6...Santino assisted with clean-up upon verbal direction.
The daily, visual schedule was referenced and reviewed in preparation for the next session...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings...

Santino was seen for session 7 of 7 in Term 3 with this SLP. The daily, visual schedule was referenced and reviewed...Goals for the session remained consistent and included the following...1. to engage in forming a relationship with Santino that includes regulation, and shared attention and interest 2. to enter into two-way, purposeful interactions with gestures and intentional communication 3. to determine highly motivating/favorable, cause and effect activities, so that Santino may develop a feeling of control and predict/anticipate what will happen next 4. to imitate predictable action sequences and communication patterns through cause and effect activities. 5. to develop single-word requesting via eye gaze, picture exchange and/or verbalization...Consideration has been given to expand upon Goal 5 to include modifier + object/action in the phrase "I want..." via picture exchange and/or verbalization...Santino was directed to an array of 4 planned activities and immediately selected the "Disney, Mickey Mouse, Pattern Tile Set" via photo exchange paired with the verbalization, "I want Mickey Shapes". New puzzle "frames" were presented upon completion and request x 3. Santino verbalized the following throughout the activity paired with photo exchange: "I want Mickey"(puzzle frame), "I want...+ the following: red hexagon, green hexagon, black hexagon, blue trapezoid, black diamond, triangle (SLP: "What color triangle?") green triangle"..."I want...+ the following: black diamond, red hexagon" (too large) So..."I want green trapezoid" followed by, "I want yellow trapezoid"..."I want Minnie Mouse" (puzzle frame), "I want green hexagon, "I want black hexagon"..."I want Pluto" (puzzle frame), "I want...+ the following:
blue triangle, green triangle, PLEASE, black diamond, red hexagon, green triangle, PLEASE" x 2. Santino appeared focused and engaged throughout. Brief moments of visual attention to each shape presented was noted...The session came to a close in the typical manner with the "Good-Bye Song" and reference to the daily, visual schedule...Continue as planned with focus on use of communication book/photos across sessions/instructors and settings...